nach oben

International Orthopaedics

Erschienen in:

20.04.2021 | Original Paper

Unicompartmental knee arthroplasty: all-poly versus metal-backed tibial component—a long-term follow-up study

verfasst von: Vincenzo Sessa, Umberto Celentano

Erschienen in: International Orthopaedics | Ausgabe 12/2021

Einloggen, um Zugang zu erhalten

Abstract

Introduction

While considered a satisfactory solution, unicompartmental knee arthroplasty (UKA) still raises concerns in regard to its durability. These concerns particularly focus on the tibial component. This study aims to compare two different cemented tibial components belonging to the same UKA design: all polyethylene (AP) versus metal backed (MB), at a long-term follow-up.

Materials and methods

We retrospectively reviewed 143 successive patients, 83 of which underwent surgery with AP tibial component UKA (37 males, 46 females), and 67 with MB ones (17 males, 50 females). All implants had the same prosthetic design (Accuris UKA, Smith e Nephew) with identical femoral oxinium component but different tibial component, AP or MB. The KSS and KOOS were assessed at a mean of 11.5-year follow-up and compared to pre-operative, post-operative, and one year evaluation. Statistical analysis was performed with SPSS for Mac (version 17.0). To assess potential statistically significant differences, t test was used and significance was set at P < 0.05.

Results

Final KSS at a mean of 11.5-year follow-up was 94.27 for the AP group and 96.12 for the MB ones. The final KOOS was 87 for AP components and 89.67 for the MB group. These results demonstrated, in all cases, statistically significant better results for MB tibial components compared to AP regarding KSS (P = 0.048), KOOS (P = 0.000), and pain (P = 0.014) at the 11.5-year follow-up. Survivorship for AP tibial component implants was 97.6%, while it was 89.5% for MB ones.

Conclusion

While the survivorship rate has been found to be greater for AP implants compared to MB tibial components, this study reveals statistically better functional results according to KSS and KOOS, and pain, at a long-term follow-up for MB implants.

Niinimäki T, Eskelinen A, Mäkelä K, Ohtonen P, Puhto AP, Remes V (2014) Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship: a 27-year Finnish registry study. Clin Orthop Relat Res 472(5):1496–1501. https://doi.org/10.1007/s11999-013-3347-2CrossRefPubMed

Liddle AD, Pandit H, Judge A, Murray DW (2015) Optimal usage of unicompartmental knee arthroplasty: a study of 41,986 cases from the National Joint Registry for England and Wales. Bone Joint J 97-B(11):1506–1511. https://doi.org/10.1302/0301-620X.97B11.35551CrossRefPubMed

Saenz CL, McGrath MS, Marker DR, Seyler TM, Mont MA, Bonutti PM (2010) Early failure of a unicompartmental knee arthroplasty design with an all-polyethylene tibial component. Knee 17(1):53. https://doi.org/10.1016/j.knee.2009.05.007CrossRefPubMed

Hutt JR, Farhadnia P, Masse V, LaVigne M, Vendittoli PA (2015) A randomised trial of all-polyethylene and metal-backed tibial components in unicompartmental arthroplasty of the knee. Bone Joint J 97-B:786–792. https://doi.org/10.1302/0301-620X.97B6.35433CrossRefPubMed

Koh IJ, Suhl KH, Kim MW, Kim MS, Choi KY, In Y (2017) Use of all-polyethylene tibial components in unicompartmental knee arthroplasty increases the risk of early failure. J Knee Surg 30(8):807. https://doi.org/10.1055/s-0036-1597979CrossRefPubMed

Small SR, Berend ME, Ritter MA, Buckley CA, Rogge RD (2011) Metal backing significantly decreases tibial strains in a medial unicompartmental knee arthroplasty model. J Arthroplast 26:777–782. https://doi.org/10.1016/j.arth.2010.07.021CrossRef

Scott CE, Eaton MJ, Nutton RW, Wade FA, Pankaj P, Evans SL (2013) Proximal tibial strain in medial unicompartmental knee replacements: a biomechanical study of implant design. Bone Joint J 95-B:1339–1347. https://doi.org/10.1302/0301-620X.95B10.31644CrossRefPubMed

Kumar V, Hasan O, Umer M, Baloch N (2019) Cemented all-poly tibia in resource constrained country, affordable and cost-effective care. Is it applicable at this era? Review article. Ann Med Surg (Lond) 47:36–40. Published 2019 Sep 27. https://doi.org/10.1016/j.amsu.2019.09.010CrossRef

Voigt J, Mosier M (2011) Cemented all-polyethylene and metal-backed polyethylene tibial components used for primary total knee arthroplasty: a systematic review of the literature and meta-analysis of randomized controlled trials involving 1798 primary total knee implants. J Bone Joint Surg Am 93(19):1790–1798. https://doi.org/10.2106/JBJS.J.01303CrossRefPubMed

10.

Newman J, Pydisetty RV, Ackroyd C (2009) Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg (Br) 91:52–57. https://doi.org/10.1302/0301-620X.91B1.20899CrossRef

11.

Forster-Horvath C, Artz N, Hassaballa MA, Robinson JR, Porteous AJ, Murray JR, Newman JH (2016) Survivorship and clinical outcome of the minimally invasive Uniglide medial fixed bearing, all-polyethylene tibia, unicompartmental knee arthroplasty at a mean follow-up of 7.3 years. Knee 23(6):981. https://doi.org/10.1016/j.knee.2016.07.003CrossRefPubMed

12.

Bruni D, Gagliardi M, Akkawi I, Raspugli GF, Bignozzi S, Marko T, Bragonzoni L, Grassi A, Marcacci M (2016) Good survivorship of all-polyethylene tibial component UKA at long-term follow-up. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 24(1):182. https://doi.org/10.1007/s00167-014-3361-2CrossRef

13.

Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN (2012) The new knee society knee scoring system. Clin Orthop Relat Res 470(1):3–19. https://doi.org/10.1007/s11999-011-2135-0CrossRefPubMed

14.

Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998 Aug) Knee Injury and Osteoarthritis Outcome Score (KOOS)-development of a self-administered outcome measure. J Orthop Sports Phys Ther 28(2):88–96. https://doi.org/10.2519/jospt.1998.28.2.88CrossRefPubMed

15.

Nouta KA, Verra WC, Pijls BG, Schoones JW, Nelissen RG (2012) All-polyethylene tibial components are equal to metal-backed components: systematic review and meta-regression. Clin Orthop Relat Res 470(12):3549–3559. https://doi.org/10.1007/s11999-012-2582-2CrossRefPubMedPubMedCentral

16.

Gioe TJ, Sinner P, Mehle S, Ma W, Killeen KK (2007) Excellent survival of all-polyethylene tibial components in a community joint registry. Clin Orthop Relat Res 464:88–92. https://doi.org/10.1097/BLO.0b013e31812f7879CrossRefPubMed

17.

Bettinson KA, Pinder IM, Moran CG, Weir DJ, Lingard EA (2009) All-polyethylene compared with metal-backed tibial components in total knee arthroplasty at ten years. A prospective, randomized controlled trial. J Bone Joint Surg Am 91(7):1587–1594. https://doi.org/10.2106/JBJS.G.01427CrossRefPubMed

18.

Longo UG, Ciuffreda M, D’Andrea V, Mannering N, Locher J, Denaro V (2017) All-polyethylene versus metal-backed tibial component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25(11):3620–3636. https://doi.org/10.1007/s00167-016-4168-0CrossRefPubMed

19.

Mohan V, Inacio MC, Namba RS, Sheth D, Paxton EW (2013) Monoblock all-polyethylene tibial components have a lower risk of early revision than metal-backed modular components. Acta Orthop 84(6):530–536. https://doi.org/10.3109/17453674.2013.862459CrossRefPubMedPubMedCentral

20.

Rouanet T, Combes A, Migaud H, Pasquier G (2013) Do bone loss and reconstruction procedures differ at revision of cemented unicompartmental knee prostheses according to the use of metal-back or all-polyethylene tibial component? Orthop Traumatol Surg Res 99(6):687–692. https://doi.org/10.1016/j.otsr.2013.03.018CrossRefPubMed

21.

Scott CEH, Wade FA, MacDonald D, Nutton RW (2018) Ten-year survival and patient-reported outcomes of a medial unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component. Arch Orthop Trauma Surg 138(5):719–729. https://doi.org/10.1007/s00402-018-2908-yCrossRefPubMedPubMedCentral

22.

Simpson DJ, Price AJ, Gulati A, Murray DW, Gill HS (2009) Elevated proximal tibial strains following unicompartmental knee replacement—a possible cause of pain. Med Eng Phys 31:752–757. https://doi.org/10.1016/j.medengphy.2009.02.004CrossRefPubMed

23.

van der List JP, Kleeblad LJ, Zuiderbaan HA, Pearle AD (2017) Mid-term outcomes of metal-backed unicompartmental knee arthroplasty show superiority to all-polyethylene unicompartmental and total knee arthroplasty. HSS J 13(3):232–240. https://doi.org/10.1007/s11420-017-9557-5CrossRefPubMedPubMedCentral

24.

Costa GG, Lo Presti M, Grassi A, Agrò G, Cialdella S, Mosca M, Caravelli S, Zaffagnini S (2020) Metal-backed tibial components do not reduce risk of early aseptic loosening in unicompartmental knee arthroplasty: a systematic review and meta-analysis. J Knee Surg 33(2):180–189. https://doi.org/10.1055/s-0038-1677506CrossRefPubMed

25.

Lustig S, Paillot JL, Servien E, Henry J, Ait Si Selmi T, Neyret P (2009) Cemented all polyethylene tibial insert unicompartmental knee arthroplasty: a long term follow-up study. Orthop Traumatol Surg Res 95:12–21. https://doi.org/10.1016/j.otsr.2008.04.001CrossRefPubMed

26.

Manzotti A, Confalonieri N, Pullen C (2007) Unicompartmental versus computer-assisted total knee replacement for medial compartment knee arthritis: a matched paired study. Int Orthop 31:315–319. https://doi.org/10.1007/s00264-006-0184-xCrossRefPubMed

27.

Sessa V, Paciotti M, Celentano U, Papalia R. Two peg versus flat tibial tray design in unicompartmental knee arthroplasty. Oral presentation 19° EFORT Congress, Barcelona 30 may - 01 june, 2018

Titel: Unicompartmental knee arthroplasty: all-poly versus metal-backed tibial component—a long-term follow-up study
verfasst von: Vincenzo Sessa
Umberto Celentano
Publikationsdatum: 20.04.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 12/2021
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-021-05031-3

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Introduction

Materials and methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 12/2021

Comment on article by Eggeling et al.: Clinical results after very early, early, and late arthroscopic arthrolysis of the knee

A higher reliability with a computed tomography scan-based three dimensional technique than with a two dimensional measurement for lower limb discrepancy in total hip arthroplasty planning

Staged reconstruction of unilateral neglected hip dislocation through total hip arthroplasty and subsequent intramedullary femoral lengthening

The Casuccio-Santacroce-Banfo knee arthroscope: an avant-garde Italian tale in the history of arthroscopy

Long-term outcomes after partial patellectomy in comminuted fractures — a clinical study

Straight nail insertion through a laterally shifted entry for diaphyseal atypical femoral fractures with bowing: good indications and limitations of this technique